Tuesday, January 27, 2015

Good step by AG Healey. Next steps?

Brava to the new Massachusetts Attorney General, Maura Healey, for indicating her displeasure with the Partners Healthcare System deal submitted by her predecessor.  I'm guessing that the Court is now very unlikely to appprove the proposed settlement.  That's good.

What next?  It would be tempting to view this question of system expansion as solely a Partners issue.  After all, they have extensive market power.  But the fact is that all of the major systems in the state are acting to expand their reach through mergers and acquisitions.

It's time to put a stop to all such anti-competitive activities.

There is simply no reason that major academic medical centers need to own community hospitals and physician groups to accomplish the purposes of creating accountable care organizations.  Clinical relationships that bring about appropriately managed care are not a matter of corporate structure.  They require, instead:

1) Complete interoperability of electronic medical records among the various segments of the health care spectrum of care; so that no one "owns" a patient and s/he is free to choose the best place to get care;
2) Transparency of financial charges and relationships between and among hospitals, doctors, and other health care facilities so that patients and referring doctors can see what the true costs of care will be in different settings;
3) Transparency of clinical outcomes so that referring doctors (and patients) can make decisions about the right venue for care based on evidence, rather than anecdote and conjecture.

Here's what the new AG should do.  She should establish a "safe harbor" for mergers and acquisitions only after the state as a whole has put these standards and practices in place.  Until then--whether it is PHS, BIDMC, Lahey, Steward, or Tufts--no more acquisitions or mergers should be permitted.


nonlocal MD said...

You make very good points. I am angry at the literally hundreds of thousands of FTE hours that hospital system executives have devoted in recent years to efforts to expand their market power rather than improve their patient care and safety. What an incredible waste as well as dereliction of duty.

Barry Carol said...

Who has the power to make price transparency happen? Will it require legislation that the governor needs to sign? Can regulators require it? Is it up to providers and insurers to agree to it by amending existing contracts or including it as part of new contracts? Even with price transparency, though, defining and measuring quality will be quite a challenge, I think.

Retited doc said...

Great summary of the nonsense going on in healthcare under the guise of improvement under the veil of ACAs. Hospital execs see health care providers and patients as profit centers to be captured and contained. Steward uses the expression "leakage" as though it was a measure of something other than the loss of healthcare dollars to another system and has NOTHING to do with good healthcare. Healthcare execs do not care for patients----they care for dollars, bricks and mortar. Someone with cohones will have to push this process into the light of day beyond the reach of insurers and hospital execs. It will require legislation to get transparency and real metrics regarding quality. Until then, all the hospital systems are playing Pacman and paying their execs millions to do so.

Anonymous said...

Your proposal is interesting but unfair to those systems that don't already have strong networks.

Partners already has 10 hospitals and by far the largest physician network in the state.

BID (your old firm)....has many relationships Atrius the largest "independent" physician group in the state is an affiliate as are Anna Jaques Hospital, Lawrence General, the two hospital Cambridge Health Alliance, Signature Healthcare Brockton, BID Plymouth, BID Milton and BID Needham,

plus Mount Auburn and New England Baptist have relationships through Caregroup and ongoing

Children's has relationships with Winchester, Beverly, South Shore and South Coast hospitals the most of the Steward Hospitals for pediatric care.

BID and Childrens also have major suburban outposts in places like Lexington, in the case of Childrens in Waltham.

So the Harvard hospitals have major networks in place, but Tufts Medical and Boston Medical have yet to build out networks.

Dana Farber has relationships with Partners, St Elizabeths and St Anne's at Steward and has bought the old Commonwealth Hematology and Oncology, a major suburban oncology network built by Tufts and B.U. affiliates.

Unless the current BID, Dana Farber, and Children's relationships are undone, doesn't seem fair to freeze the current network structure in place.

That would be a little like freezing the current Partners pricing advantage in place.

Tufts Med and Boston Med should be given free reign to build networks at least until they level the playing field.

I agree that the other Boston area Academic Medical Centers should be frozen.

Lise said...

Chapter 224 includes a price transparency requirement. The law requires providers and insurers to provide a cost estimate to patients within 3 days, including an estimate of the allowed and most importantly, the out of pocket amount. The State needs to do more to publicize this requirement. As tiered networks grow and resulting cost of choosing the highest cost providers grow, patients need to be able to know the cost of their selected provider Before they book the procedure, test, surgery or inpatient admission, not afterwards, when they receive the bill. This was the intent of the law.

Barry Carol said...

The section 224 provision requiring hospitals to provide patients with a cost estimate ahead of time for care that is scheduled in advance is a fine idea. However, what happens if the estimate turns out to be wide of the mark or otherwise wrong? It needs to be a binding estimate that patients can rely on. If there are unexpected costs that the patient wasn’t made aware of, he shouldn’t be responsible for paying them.